Esophageal granular cell tumor and eosinophilic esophagitis: two interesting entities identified in the same patient

Abstract

We illustrate the case of a 41-year-old male with allergic manifestations since childhood. He sought medical attention for intermittent, progressive dysphagia from which he had been suffering for a number of years, having felt the sensation of a retrosternal lump and a self-limited obstruction to the passage of food. Endoscopy detected a submucosal tumor in the upper third of the esophagus, which was typified, via biopsy, as a granular cell tumor with benign characteristics and probably responsible for the symptoms. Two years later, the patient sought medical attention once again as these symptoms had not abated, hence digestive endoscopy was repeated. This revealed stenosis of the junction between the middle and lower thirds of the organ which had not been detected previously but was passable under gentle pressure. Eosinophilic esophagitis was detected after biopsies were taken. Esophageal manometry identified a motor disorder affecting the esophageal body. Following three months of treatment using fluticasone propionate applied topically, the symptoms went into remission, esophageal stenosis disappeared and the esophageal biopsies returned to normal. This is the first documented case of the link between granular cell tumors and Eosinophilic esophagitis, two different disorders which could cause dysphagia in young patients.

Keywords: Dysphagia; Eosinophilic esophagitis; Esophagus; Granular cell tumors.

Fig. 1

Endoscopic image of our case, which shows a millimetric and yellowish ‘molar-like’ nodule located in the upper esophagus, impressed into the submucosa.

Fig. 2

Tissue preparation within which tumor proliferation nests or cords may be observed, immediately below the esophageal epithelium showing signs of hyperplasia with acanthosis and papillomatosis (HE 200×).

Fig. 3

Biopsy taken over the distal esophageal third, showing regenerative changes expressed like hyperplasia of basal cells and acanthosis, into epithelium containing intercellular edema and eosinophilic infiltration (HE 200×).